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Purpose: Hypertension has a high prevalence in general population and it is one of the most important risk factors for heart disease and heart failure (HF). A subgroup of these patients show a depressed left ventricular (LV) ejection fraction (EF) and can be defined as Hypertensive Dilated Cardiomyopathy (HDCM). This syndrome is poorly described and no data are presently available on prevalence and prognostic impact of left ventricular reverse remodelling (LVRR) in this disease under treatment. Therefore, the aims of the present study were to evaluate the prevalence of LVRR in HDCM patients under tailored medical treatment and its prognostic implication.Methods: We selected patients with documented history of hypertension and depressed LV EF(<50%) at onset referred to our Cardiovascular Department from January2000 to December 2009. Patients with coronary artery disease (CAD),valvular, congenital, alcohol abuse (cut-off: 100 g/die) were excluded. Finally 114 out of these 2022 hypertensive patients (5%) were classified as HDCM. LVRR was defined at 9 months follow-up as the combination of: a) an increase of LVEF of at least 10 points or follow-up LVEF>50%;and b) a decrease in indexed left ventricular end-diastolic diameter of at least 10% or a follow-up indexed left ventricular end-diastolic diameter <3,3cm/m2. All patients underwent a complete evaluation at baseline and during a structured follow up.Results: Out of HDCM patients (89 % males, age62±11 years, LVEF 31±10%, NYHA III-IV 25%), 9-months follow-up clinical and echocardiographic data were available in 94 of them (83 %)(LVEF43±11%, NYHA III-IV 7%). LVRR was found in 41 patients (36%). During a mean follow-up of 43±32 months, 15 patients (13%) died (cardiac death 10 of them 8,8%), and none was transplanted.The survival free from cardiac death was 95%, 93% and 69% at 2, 5 and 10 years, respectively. LVEF < 35% at 9 month follow-up emerged as predictor factor of death (p= 0.01) at 5 year follow-up. Conclusions: Our preliminary results suggest that HDCM is characterized by impressive benign outcome under tailored medical treatment. One third of ourpatients showed LVRR at 9 months follow-up under tailored treatment. This observation is probably due to the effect of drugs antagonizing the neurohormonal system.